OBJECTIVE: To describe a new and safe technique for draining the residual pancreatic duct after pancreaticoduodenectomy. DESIGN: Open study. SETTING: University Hospital, Herakleion, Crete. SUBJECTS: Eight patients with histological proved cancer of the periampullary region. INTERVENTIONS: Pancreaticoduodenectomy (Whipple procedure), after which the remnant of the pancreatic duct was not anastomosed to the jejunum but drained externally through a soft polyethylene tube. All patients received total enteral or parenteral nutrition, plus somatostatin. MAIN OUTCOME MEASURES: Avoidance of the high morbidity associated with pancreaticoduodenectomy, in particular pancreatic fistula secondary to leakage from the pancreaticojejunal anastomosis. RESULTS: There was no immediate postoperative mortality or morbidity. The output from the pancreatic remnant decreased progressively, and had ceased in all cases within 20 days; the tube was removed when drainage ceased. Median hospital stay was 24 days (range 20-28). Two patients died after 9 and 11 months, respectively, and the remainder were alive at a median of 26.5 months (range 7-38). Blood glucose concentrations remained within the reference range throughout. CONCLUSION: The technique of external drainage of the pancreatic remnant can safely be combined with a Whipple procedure, ameliorating the risk of postoperative complications and at the same time preserving pancreatic endocrine function.
OBJECTIVE: To describe a new and safe technique for draining the residual pancreatic duct after pancreaticoduodenectomy. DESIGN: Open study. SETTING: University Hospital, Herakleion, Crete. SUBJECTS: Eight patients with histological proved cancer of the periampullary region. INTERVENTIONS: Pancreaticoduodenectomy (Whipple procedure), after which the remnant of the pancreatic duct was not anastomosed to the jejunum but drained externally through a soft polyethylene tube. All patients received total enteral or parenteral nutrition, plus somatostatin. MAIN OUTCOME MEASURES: Avoidance of the high morbidity associated with pancreaticoduodenectomy, in particular pancreatic fistula secondary to leakage from the pancreaticojejunal anastomosis. RESULTS: There was no immediate postoperative mortality or morbidity. The output from the pancreatic remnant decreased progressively, and had ceased in all cases within 20 days; the tube was removed when drainage ceased. Median hospital stay was 24 days (range 20-28). Two patients died after 9 and 11 months, respectively, and the remainder were alive at a median of 26.5 months (range 7-38). Blood glucose concentrations remained within the reference range throughout. CONCLUSION: The technique of external drainage of the pancreatic remnant can safely be combined with a Whipple procedure, ameliorating the risk of postoperative complications and at the same time preserving pancreatic endocrine function.
Authors: Sergio Alfieri; Giuseppe Quero; Fausto Rosa; Dario Di Miceli; Antonio Pio Tortorelli; Giovanni Battista Doglietto Journal: Updates Surg Date: 2016-09-08
Authors: Keith D Lillemoe; John L Cameron; Min P Kim; Kurtis A Campbell; Patricia K Sauter; Joann A Coleman; Charles J Yeo Journal: J Gastrointest Surg Date: 2004-11 Impact factor: 3.452